thyroid hypofunction

Question 1

lab assessment suggesting hypothyroidism

Answer 1

First test would be TSH if TSH is abnormal then test for T3 and T4, if TSH is high and T3 and T4 are low

Question 2

Hypothyroidism 1ry, 2ry and 3ry

Answer 2

primary: Thyroid gland failure
secondary: pituitary gland failure
tertiary: hypothalamus failure

Question 3

causes of primary hypothyroidism

Answer 3

Hashimoto’s thyroiditis, radioactive iodine therapy after graves disease, subacute thyroiditis ( after a while the patient enters a hypothyroidism stage)

Question 4

causes of secondary hypothyroidism

Answer 4

hypopituitarism

Question 5

causes of tertiary hypothyroidism

Answer 5

hypothalamic dysfunction

Question 6

hypothyroidism signs and symptomps

Answer 6

bradycardia, weight gain, cold intolerance, rough dry skin, unexplained edema, fatigue lethargy and depression, carpal tunnel, infertility and hyperprolactinaemia

Question 7

diagnosis of hypothyroidism

Answer 7

low free T3 and T4 and high TSH is diagnostic for hypothyroidism

Question 8

presence of thyroid auto antibodies is diagnostic for ..

Answer 8

Hashimoto’s disease

Question 9

lab findings with a secondary pituitary cause of hypothyroidism?

Answer 9

both low T3/T4 and low TSH , indication for brain MRI

Question 10

lab findings of subclinical hypothyroidism ?

Answer 10

High TSH and normal free T3/T4

Question 11

what is Hashimotos thyroiditis

Answer 11

Autoimmune disease most commonly found in children and young adults

Question 12

what antibodies are present in hashimotos thyroiditis

Answer 12

anti thyroglobulin (Tg) and anti thyroid peroxidase(TPO) antibodies

Question 13

what other autoimmune diseases may hashimotos’s thyroiditis be associated with?

Answer 13

pernicious anemia, adrenocortical insufficiency and vitiligo

Question 14

what is schmidt’s syndrome ?

Answer 14

an endocrine disorder that includes a combination of primary adrenal insufficiency, autoimmune thyroid dysfunction (hashimotos) and type 1 diabetes
Hashimotos + Addison’s disease and type 1 diabetes

Question 15

lab findings ini hashimoto’s thyroiditis

Answer 15

high levels of TSH and low levels of T3/T4, presence of anti thyroglobulin (Tg) and anti thyroid peroxidase Ab

Question 16

fine needle aspirate findings of hashimotos

Answer 16

lymphocytic infiltration and hurthle cells

Question 17

complications oh hashimotos thyroiditis

Answer 17

permanent hypothyroidism , and rarely a thyroid lymphoma

Question 18

managmenet of hashimotos thyroiditis

Answer 18

start patient on L-thyroxine at 50-100mcg but if the patient has IHD then reduce the dose to 25mcg

Question 19

how often should TSh levels be checked after L-thyroxine administration

Answer 19

after 4-6 weeks to adjust the dose of L-thyroxine

Question 20

in case of secondary hypothyroidism (pituitary cause), what to monitor

Answer 20

monitor free T4 rather than TSH

Question 21

management of hypothyroidism during pregnancy

Answer 21

thyroid function test must be monitored every month , l-thyroxine doses will be increased by 25-30%

Question 22

Myxedema coma, what is it

Answer 22

is a medical emergency , characterized by stupor, hypoglycaemia , hyponatremia, hypothermia, shock and death

Question 23

what is the classic presentation of myxedema coma

Answer 23

an obese elderly women , yellowish skin, hoarse voice, large tongue, thin hair, puffy eyes and slow reflexes , an anterior neck scar may be present (evidence of previous thyroidectomy)

Question 24

what are the general measures for myxedema coma

Answer 24

after lab confirmation , patient should be in an ICVU setting , patient should have support ventilation as respiratory failure is the main cause of death, ABG should be monitored, support blood pressure , thyroxine medication will help with the hyponatremia and hypothermia , IV glucose should be given for the hypoglycaemic

Question 25

Specific managment for Myxedema coma

Answer 25

L-thyroxine should be given 0.2 to 0.5 mg followed by 0.1 mg until orall is tolerated

Question 26

what are the precipitating factors that may occur upon administration of thyroid hormones?

Answer 26

adrenal insufficiency so hydrocortisone is usually given